Advantages of upper brachial artery cannulation in aortic surgery

The best method of cerebral protection during aortic arch surgery remains controversial. However, antegrade cerebral perfusion seems to be the most favorable because of better neurological outcomes. Although there have been many studies on antegrade cerebral perfusion via upper brachial cannulation, there is a lack of studies focusing particularly on local complications, with objective findings. The aim of this study was to investigate the local neurological and vascular complications following upper brachial cannulation.

This study included 44 patients who underwent procedures on the ascending aorta, aortic arch, or descending aorta with upper brachial artery cannulation for cardiopulmonary bypass at OSM Ortadogu Hospital and Cankaya Hospital between January 2009 and April 2012. The mean age of the 32 (72.7%) men and 12 (27.3%) women was 55.2 ± 12.3 years. Doppler analysis of the upper brachial artery was performed in 26 (59%) patients. Mean follow-up time for Doppler analysis was 5.7 ± 2 months. The mean antegrade cerebral perfusion time was 35 ± 16.1 min. The mean degree of hypothermia was 25.1 ± 2.0 . Hospital death occurred in 4 (9.1%) patients, and 2 (4.5%) suffered local neurologic complications. Electromyelography analysis was carried out in the 2 patients who suffered local neurologic symptoms.

Brachial artery cannulation is technically simple and less time consuming, thus suitable even for emergency cases. With an acceptable risk of local complications, we recommend routine use of upper brachial cannulation for antegrade cerebral perfusion.